Search Images Maps Play YouTube News Gmail Drive More »
Sign in
Screen reader users: click this link for accessible mode. Accessible mode has the same essential features but works better with your reader.

Patents

  1. Advanced Patent Search
Publication numberUS6015403 A
Publication typeGrant
Application numberUS 08/606,651
Publication dateJan 18, 2000
Filing dateFeb 26, 1996
Priority dateFeb 26, 1996
Fee statusPaid
Publication number08606651, 606651, US 6015403 A, US 6015403A, US-A-6015403, US6015403 A, US6015403A
InventorsMark S. Jones
Original AssigneeAlcon Laboratories, Inc.
Export CitationBiBTeX, EndNote, RefMan
External Links: USPTO, USPTO Assignment, Espacenet
Ophthalmic surgery probe with soft tip
US 6015403 A
Abstract
A probe for ophthalmic surgery and the like includes a handpiece terminating distally in a needle, a connector for connection to a light source such as a laser source or an illumination source, and an optical fiber for transmitting light from the light source to an eye to be treated. The optical fiber extends substantially through the handpiece needle. The needle has a soft tip to reduce the possibility of injury to the interior of the eye by contact with the metal portion of the needle. The soft tip also acts as a distance guide, allowing the user to position the optical fiber repeatedly at the same distance from the retina.
Images(3)
Previous page
Next page
Claims(5)
What is claimed is:
1. An ophthalmic probe for ophthalmic surgery and the like comprising:
a handpiece having a handpiece body and a hollow needle of a size suitable for insertion into a human eye, said hollow needle extending distally from the handpiece body and including a metal tube forming the proximal portion of the needle;
a connector for connection to a laser source or a source of illumination;
an optical fiber terminating at one end in the connector and terminating at another end generally at the distal end of the needle for transmitting light from a light source to an eye to be treated; and
a soft tip disposed at the distal end of said needle and extending distally therefrom, said soft tip being molded in place on said needle;
said needle including an outer metal tube and an inner bushing, the inner bushing extending distally from the distal end of the outer metal tube, said inner bushing also having a proximal portion disposed inside at least a portion of the outer metal tube;
the soft tip being molded in place to the inner bushing.
2. The ophthalmic probe for ophthalmic surgery and the like as set forth in claim 1 wherein the inner bushing is fixedly secured to the outer metal tube.
3. The ophthalmic probe for ophthalmic surgery and the like as set forth in claim 1 wherein the soft tip as molded has an outer diameter approximately the same as the outer diameter of the outer metal tube.
4. The ophthalmic probe for ophthalmic surgery and the like as set forth in claim 1 wherein the proximal end of the soft tip abuts the distal end of the outer metal tube.
5. The ophthalmic probe for ophthalmic surgery and the like as set forth in claim 2 wherein the inner bushing has an outer diameter substantially equal to the inner diameter of the outer metal tube, said soft tip being solely disposed distally of the distal end of the outer metal tube.
Description
BACKGROUND OF THE INVENTION

The present invention relates to ophthalmic probes for ophthalmic surgery and the like.

It is known that various probes may be used in ophthalmic surgery. Such probes may be used, for example, to introduce laser light from a laser source (which is disposed at some distance from the patient) through an optical fiber cable (which can be eight feet or so in length) to the patient. The optical fiber cable terminates proximally in a laser connector (for connection to the laser source) and terminates distally in a handpiece which is manipulated by the surgeon. Similarly, such probes can be used for illumination purposes when suitably connected to a source of illumination.

Although such systems perform their desired function, they could be improved. In such probes, it is known to include a suction and reflux system integral with the handpiece so that the suction could be delivered to the exact spot where necessary, and provides the surgeon the ability to manipulate the suction with the same hand with which he manipulates the laser or illumination. As a result, the surgeon does not have to remove the probe and replace it with a suction probe when suction is desired. This replacement leads to additional time for the procedure and the possibility of additional trauma, all of which is obviated by the known system.

However, the prior art system can be further improved. The eye is a fragile organ and can be easily injured. The probe, which is inserted into the eye, is generally made from stainless steel. This is, of course, a rigid material, which, if inadvertently brought into contact with various structures of the eye, such as the retina, could easily injure the eye.

SUMMARY OF THE INVENTION

Among the several objects and features of the present invention may be noted the provision of an improved ophthalmic probe which is especially suited for ophthalmic surgery or the like.

Another object is the provision of such a system which will protect the eye from accidental contact with the probe to reduce injury to the eye.

A third object is the provision of such a system which is reliable, yet relatively simple to manufacture.

Other objects and features will be in part apparent and in part pointed out hereinafter.

Briefly, an ophthalmic probe of the present invention includes a handpiece having a handpiece body and a hollow needle of a size suitable for insertion into a human eye, the hollow needle extending distally from the handpiece body and including a metal tube forming the proximal portion of the needle. A connector is provided for connection to a laser source or a source of illumination, and an optical fiber terminating at one end in the connector and terminating at another end generally at the distal end of the needle is provided for transmitting light from a light source to an eye to be treated. A soft tip is disposed at the distal end of said needle and extends distally therefrom, the soft tip being secured by molding to said needle.

In a second aspect of the present invention a method of making a probe for ophthalmic surgery includes the steps of providing a generally cylindrical, hollow bushing having a distal end, preparing the distal end to receive a molded soft tip of silicone or the like, molding the soft tip in place on the distal end of the bushing, securing the bushing with the soft tip molded thereto to a hollow probe needle such that the soft tip is disposed distally of the distal end of the probe needle, and securing the probe needle to a handpiece to form a probe.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view, with parts broken away for clarity, of a laser delivery system;

FIG. 2 is an enlarged sectional view taken along line 2--2 of FIG. 1;

FIG. 3 is an enlarged sectional view of the distal end of a handpiece;

FIG. 4 is a further enlarged sectional view of the distal end of a probe of the handpiece taken along line 4--4 of FIG. 3;

FIG. 5 is an enlarged sectional view, similar to FIG. 1, illustrating the handpiece of an alternative embodiment of the system of FIG. 1;

FIG. 6 is a further enlarged sectional view of the distal end of the handpiece of FIG. 5, taken along line 6--6;

FIG. 7 is a sectional view, similar to FIG. 5, illustrating another embodiment of the system of FIG. 1;

FIG. 8 is a sectional view, similar to FIGS. 4 and 6, illustrating an embodiment the distal end of the ophthalmic probe of the present invention; and

FIG. 9 is an enlarged view showing the relationship of the optical fiber, needle, and soft tip of the probe of FIG. 8.

Similar reference characters indicate similar parts throughout the several views of the drawings.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

Turning to FIG. 1, a laser delivery system 11 includes a handpiece 13 (with a distal end portion 21), a light source connector 15 (which, as is known, will vary depending upon whether the connector is designed for connection to a laser source or illumination source), and an optical fiber cable 17. Handpiece 13 has a handpiece body 18 made up of a handpiece proximal end portion 19, handpiece distal end portion 21, and a reflux sleeve 23. A hollow needle 25 of a size suitable for insertion into a human eye extends distally from the handpiece body. Needle 25 preferably includes an outer metal tube or probe needle approximately one and three-quarters inches long which is suitably secured in the distal end of the handpiece body with approximately 1.38 inches of the tube exposed distally from the handpiece body. The outer diameter of the metal tube is, for example, approximately 0.0355 inch, and its inner diameter is approximately 0.030 inch. These dimensions are illustrative of those for a tip suitable for insertion in the human eye.

Connector 15 may be of any desired construction suitable for connection to a light source (not shown). The construction shown is illustrative only.

As can be readily seen in FIG. 1, optical fiber cable 17 terminates proximally in connector 15 in such a manner that it is exposed to the light (whether laser light or illumination) from the light source. The optical cable extends for any desired length (such an eight feet or so) and terminates distally generally at the distal end of the needle 25 of handpiece 13. Optical fiber cable 17 thereby forms an optical path for the light from the light source to an eye being treated.

Also shown in FIG. 1 is a clamp 29 having jaws 29A used to removably secure cable 17 to any appropriate structure to hold the cable in place without significantly restricting movement of the handpiece by the surgeon.

Turning to FIG. 2, there is shown on a greatly enlarged scale the relationship between optical cable 17 and needle 25. The portion of optical cable 17 which is disposed in needle 25, namely an unsheathed optical fiber 17A, has an outer diameter of approximately 0.013", for example, while the inner diameter of the tip is approximately 0.020." This difference in diameter leaves a gap 31 disposed between the optical fiber and the tip. This gap runs the entire length of the tip and forms a fluid path from the distal end of needle 25 to the interior of the handpiece body.

Note that if the optical fiber were secured to needle 25 by adhesive (as has been done previously), the adhesive would tend to block off gap 31. To prevent this, the optical fiber is not secured directly to probe 25 at all. Instead it is suitably secured to proximal end portion 19 of the handpiece body. Note as well that, although the optical fiber 17 is shown centered in needle 25 in FIG. 2, the fiber can in fact be off-center in the tip without closing off gap 31.

The fluid path formed by gap 31 is in fluid communication with a cavity 33 (FIG. 1) in handpiece distal end 21. Cavity 33, in turn, is connected to a source of suction, as is known in the prior art. This allows fluid and other material to be withdrawn through the gap. Preferably, the distal end of this fluid path is disposed immediately adjacent the spot where the light exits the probe, so that removal of fluid from the operative site takes place almost exactly where needed.

The distal end 41 (see FIGS. 3 and 4) of needle 25 is provided with a tip 43 made of a soft pliable material, preferably silicone. This soft tip serves as a buffer between the structures of the eye and the metal portion of probe 25 (labeled 25A in FIG. 4), to prevent accidental injury to the eye structure caused by contact of the eye structure with the metal portion 25A of the needle, and to act as a distance guide, allowing the user to position the optical fiber repeatedly at the same distance from the retina. The tip 43 is made from a tube of silicone 45 (FIGS. 2 and 4) which is received within the needle metal portion 25A. Tube 45 is molded in place on a bushing 47 (FIGS. 2 and 4), and bushing 47 is bonded to metal portion 25A. Tube 45 extends over bushing 47 and the bushing and tube are received within metal portion 25A of needle 25. Tip 43 extends beyond the distal end of the metal portion of bushing 47 by approximately 0.030"--0.030". Tip 43 is pliable and flexible and is thus bendable. Bushing 47 extends beyond the metal portion of probe 25 by approximately 0.100" to add sufficient rigidity to tip 43 to prevent it from bending to a point where it would interfere with the beam and to provide sufficient shear strength to insure that tube 45 will not dislodge from bushing 47.

Soft tubing 45 is preferably 0.036" in outer diameter. This is approximately equal to the outer diameter of needle metal portion 25A and is greater than the 0.030" inner diameter of the metal needle portion 25A (and also greater than, or at least equal to, the 0.021" inner diameter of bushing 47). To affix tube 45 within probe metal portion 25A, the bushing 47 is bonded to metal needle portion 25A.

Turning to FIGS. 5 and 6, a second embodiment of the present invention differs from the previous embodiment (and alternatively from the third embodiment described below) in that the distal end of the needle (labeled 25A) is curved. This enables the surgeon to access parts of the posterior segment (the interior of the eye behind the lens) that a straight needle cannot reach. Except for the curve on the end, the curved and straight needles are substantially the same so far as the present invention is concerned. The distal end of the needle is curved to form an angle (such as the 40 degree angle shown in FIG. 5) with respect to the longitudinal axis of the needle and handpiece. The needle is preferably bent starting proximal to the soft tip 43 itself (as best seen in FIG. 6). Alternatively, the bend could start at the tip itself, but that would complicate the bending process, and would not significantly improve the usability of the device by the surgeon. Although the particular radius of the curved portion of the tip can vary, depending upon the desired application, a radius of approximately 1/4" was used in the device of FIGS. 5 and 6.

Turning to FIG. 7, yet another embodiment of the handpiece is shown. This handpiece, labeled 13A, differs from that of FIG. 5 mainly in that the distal portion 21A of the handpiece does not include the reflux capability of the handpieces of FIGS. 1, and 5. It has no provision for passive aspiration.

Typically, port 51 of the handpiece is connected to a syringe or a typical surgery machine that can supply suction for active aspiration. Handpiece 13A can function well without reflux because of the soft tip 43 and the type of suction used. For example, if the surgeon uses passive aspiration with the device of FIG. 1, it is possible for a membrane or part of the retina to be caught on the probe tip. Because fragile tissue caught in the hard tip of FIG. 1 will probably tear if the surgeon tries to pull the probe away, the reflux capability of the probe of FIG. 1 allows the surgeon to reflux the captured material back into the eye without damage to these fragile tissues.

When the surgeon uses passive aspiration with a probe having soft tip 43, it is doubtful whether any tissues caught in the tip would tear when the surgeon would try to pull the tip away. In that case the reflux capability of the probes shown in FIGS. 1 and 5 is not necessary. If the surgeon uses active aspiration with a probe having soft tip 43, the soft tip again reduces the possibility of tearing as the probe is pulled away. In any event, however, with active aspiration the aspiration or suction source may be used to provide reflux without the separate reflux structure shown in FIGS. 1 and 5. For these applications, the handpiece of FIG. 7 without the separate reflux structure works well, is simpler to make, and is relatively less expensive than the embodiments of FIGS. 1 and 5.

A preferred embodiment of the ophthalmic probe of the present invention is disclosed in FIGS. 8 and 9. In this embodiment, outer metal tube 25a is secured by a suitable adhesive to inner bushing 47a. Note that in this embodiment, the soft tip 45a is not captured between the outer metal tube and the bushing. Rather, the soft tip is molded in place on the bushing, and the bushing is then secured to the outer metal tube. Specifically, in this embodiment, bushing 47a is sized to fit snugly within outer metal tube 25a. The outer surface of bushing 47a is sand blasted with 75μ silica sand and a suitable primer such as the primer sold under the trade designation CF2-135 silicone primer by Nusil Technology is applied to the outer surface of the bushing as well. It is preferred that this mechanical and chemical treatment be applied to approximately the distalmost 1/10" of bushing 47a. After the outer surface of the bushing is suitably prepared, it is inserted into a suitable mold cavity (not shown) and silicone tip 45a is molded in place about the distal end of the bushing in the shape as shown in FIG. 8. A suitable material for tip 45a is the 70 durometer silicone sold under the trade designation LSR 4070 by Miles Baysilone. It has been found that this method of attachment of the soft tip to the bushing results in superior attachment characteristics. After the soft tip is molded in place, the bushing with attached soft tip is suitably glued to outer metal tube 25a to form the completed structure shown in FIG. 8. It is preferred that the gripping surface of the soft tip on the bushing extend longitudinally along the bushing for approximately 1/10". The portion of the soft tip extending distally of the bushing is preferably 0.02" or so. The bushing itself is approximately 0.23" in length, while the outer metal tube (forming the outer surface of the needle) is considerably longer.

It is preferred that the outer diameter of the soft tip be approximately the same and the outer diameter of outer metal tube 25a and that the soft tip abut the outer metal tube with only a minimal gap (i.e., 0.005") if any. The inner diameter of the soft tip is, for example, 0.022", which corresponds closely to the inner diameter of bushing 47a.

As shown in FIG. 9, once the optical fiber 17a is fixed in place, it preferably extends slightly beyond the distal end of bushing 47a, but stops proximally of the distal end of the soft tip.

In view of the above it will be seen that the various objects and features of the above described invention are achieved and other advantageous results obtained. The description and drawings of the present invention contained herein are illustrative only and are not to be interpreted in a limiting sense.

Patent Citations
Cited PatentFiling datePublication dateApplicantTitle
US5201730 *Jan 3, 1992Apr 13, 1993Surgical Technologies, Inc.Tissue manipulator for use in vitreous surgery combining a fiber optic endoilluminator with an infusion/aspiration system
US5203353 *Jan 3, 1992Apr 20, 1993Surgical Technologies, Inc.Method of penetrating and working in the vitreous humor of the eye
US5275593 *Apr 30, 1992Jan 4, 1994Surgical Technologies, Inc.Ophthalmic surgery probe assembly
US5300061 *Aug 29, 1991Apr 5, 1994Surgical Technologies, Inc.Laser delivery probe having a mechanically free floating sheath
US5441496 *Apr 15, 1993Aug 15, 1995Infinitech, Inc.Laser delivery system with soft tip
Referenced by
Citing PatentFiling datePublication dateApplicantTitle
US6800076 *Oct 18, 2001Oct 5, 2004Retinalabs, Inc.Soft tip cannula and methods for use thereof
US7094057 *Sep 13, 2002Aug 22, 2006Joshua FriedmanDental light curing member and method
US7402158 *Aug 17, 2005Jul 22, 2008Synergetics, Inc.Directional laser probe
US7473249Jan 9, 2006Jan 6, 2009Synergetics, Inc.Directional laser probe
US7537593Sep 4, 2004May 26, 2009Retinalabs.Com, Inc.Soft tip cannula and methods for use thereof
US7980745 *Jun 30, 2008Jul 19, 2011Ramsey ShanbakyBroad spectrum fiber optic base laser illumination
US8075553Aug 11, 2006Dec 13, 2011Synergetics, Inc.Illuminated directional laser probe
US8162928 *Apr 24, 2012D.O.R.C. Dutch Ophthalmic Research Center (International) B.V.Eye surgical instrument
US8246631Nov 30, 2004Aug 21, 2012Bausch & Lomb IncorporatedTwo stage plunger for intraocular lens injector
US8317382Dec 6, 2010Nov 27, 2012Alcon Research, Ltd.Enhanced LED illuminator
US8348430Oct 13, 2010Jan 8, 2013Alcon Research, Ltd.Photonic lattice LEDs for ophthalmic illumination
US8371694Nov 17, 2010Feb 12, 2013Alcon Research, Ltd.Bichromatic white ophthalmic illuminator
US8425473Apr 23, 2013Iscience Interventional CorporationSubretinal access device
US8535332Jul 24, 2012Sep 17, 2013Bausch & Lomb IncorporatedTwo stage plunger for intraocular lens injector
US8573801Sep 16, 2011Nov 5, 2013Alcon Research, Ltd.LED illuminator
US8900220Jan 19, 2011Dec 2, 2014D.O.R.C. Dutch Ophthalmic Research Center (International) B.V.Eye surgical instrument
US8945058Nov 21, 2007Feb 3, 2015Applied Medical Resources CorporationTrocar cannula with atraumatic tip
US9314374Mar 19, 2010Apr 19, 2016Alcon Research, Ltd.Stroboscopic ophthalmic illuminator
US9335455May 29, 2013May 10, 2016Cygnus, LPExtended tip laser and illumination probe for retina surgery
US9370447 *Oct 10, 2011Jun 21, 2016Cygnus LPProbes for use in ophthalmic and vitreoretinal surgery
US20020121281 *Oct 18, 2001Sep 5, 2002Mark HumayunSoft tip cannula and methods for use thereof
US20040053189 *Sep 13, 2002Mar 18, 2004Joshua FriedmanDental light curing member and method
US20040111133 *Sep 25, 2003Jun 10, 2004Alcon, Inc.LED illuminator
US20050033272 *Sep 4, 2004Feb 10, 2005Retinalabs, Inc.Soft tip cannula and methods for use thereof
US20050113814 *Nov 24, 2003May 26, 2005Loeb Marvin P.Apparatus and method for limiting the re-use of fiber optic, laser energy delivery devices
US20060004348 *Aug 17, 2005Jan 5, 2006Scheller Gregg DDirectional laser probe
US20060173448 *Jan 9, 2006Aug 3, 2006Scheller Gregg DDirectional laser probe
US20080097420 *Apr 12, 2007Apr 24, 2008D.O.R.C. Dutch Ophthalmic Research Center (International) B.V.Eye Surgical Instrument
US20080287938 *Aug 11, 2006Nov 20, 2008Synergetics, Inc.Illuminated Directional Laser Probe
US20090043321 *Apr 29, 2005Feb 12, 2009Iscience Interventional CorporationApparatus And Method For Surgical Enhancement Of Aqueous Humor Drainage
US20090054957 *Jun 30, 2008Feb 26, 2009Iris, IncBroad spectrum fiber optic base laser illumination
US20090216244 *Nov 30, 2004Aug 27, 2009Joel PynsonTwo Stage Plunger for Intraocular Lens Injector
US20100100045 *Nov 21, 2007Apr 22, 2010Applied Medical Resources CorporationTrocar cannula with atramatic tip
US20100125278 *Nov 19, 2008May 20, 2010Wagner Christopher EHard and Soft Tip Intraocular Lens Injector System and Method
US20100173866 *Oct 30, 2009Jul 8, 2010Iscience Interventional CorporationApparatus and method for ocular treatment
US20100191176 *Jan 23, 2009Jul 29, 2010Iscience Interventional CorporationSubretinal access device
US20100191177 *Jan 23, 2009Jul 29, 2010Iscience Interventional CorporationDevice for aspirating fluids
US20100292681 *Oct 3, 2008Nov 18, 2010El.En. S.P.A.Device for the use, also single use, of an optical fiber for invasive surgical laser treatment in the human body
US20110118711 *May 19, 2011D.O.R.C. Dutch Ophthalmic Research Center (International) B.V.Eye Surgical Instrument
US20110148304 *Nov 17, 2010Jun 23, 2011Artsyukhovich Alexander NThermoelectric cooling for increased brightness in a white light l.e.d. illuminator
US20110149246 *Jun 23, 2011Alexander ArtsyukhovichPhotonic lattice LEDs for ophthalmic illumination
US20110149247 *Jun 23, 2011Alexander ArtsyukhovichBichromatic white ophthalmic illuminator
US20110149591 *Jun 23, 2011Smith Ronald TEnhanced LED illuminator
US20110230728 *Mar 19, 2010Sep 22, 2011Artsyukhovich Alexander NStroboscopic ophthlamic illuminator
EP1250900A2 *Feb 22, 2002Oct 23, 2002Glautec AGGlaucoma treatment device
WO2009044424A1Oct 3, 2008Apr 9, 2009El.En. S.P.A.Device for the use, also single use, of an optical fiber for invasive surgical laser treatment in the human body
WO2011053512A1 *Oct 21, 2010May 5, 2011Iscience Interventional CorporationApparatus and method for ocular treatment
Classifications
U.S. Classification606/4, 606/13
International ClassificationA61B19/00, A61F9/011
Cooperative ClassificationA61B2090/036, A61B2090/08021, A61F2009/00863, A61F9/008
European ClassificationA61F9/008
Legal Events
DateCodeEventDescription
Apr 26, 1996ASAssignment
Owner name: INFINITECH, INC., MISSOURI
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:JONES, MARK S.;REEL/FRAME:007909/0317
Effective date: 19960223
Jan 26, 1999ASAssignment
Owner name: INNOVATION MEDICAL TECHNOLOGIES,INC., TEXAS
Free format text: MERGER;ASSIGNORS:INFINITECH,INC.;SURGICAL TECHNOLOGY,INC.;REEL/FRAME:009711/0429
Effective date: 19981231
Feb 4, 1999ASAssignment
Owner name: ALCON LABORATORIES, INC., TEXAS
Free format text: MERGER;ASSIGNOR:INNOVATION MEDICAL TECHNOLOGIES, INC.;REEL/FRAME:009737/0020
Effective date: 19981231
Owner name: ALCON LABORATORIES, INC., TEXAS
Free format text: MERGER;ASSIGNOR:INNOVATION MEDICAL TECHNOLOGIES, INC.;REEL/FRAME:009737/0012
Effective date: 19981231
Feb 12, 1999ASAssignment
Owner name: ALCON LABORATORIES, INC., TEXAS
Free format text: MERGER;ASSIGNOR:INNOVATION MEDICAL TECHNOLOGIES, INC.;REEL/FRAME:009764/0553
Effective date: 19981231
Mar 26, 2001ASAssignment
Owner name: ALCON MANUFACTURING, LTD., TEXAS
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:ALCON LABORATORIES, INC.;REEL/FRAME:011667/0559
Effective date: 20010322
Jul 18, 2003FPAYFee payment
Year of fee payment: 4
Jul 18, 2007FPAYFee payment
Year of fee payment: 8
Jul 21, 2008ASAssignment
Owner name: ALCON RESEARCH, LTD., TEXAS
Free format text: MERGER;ASSIGNOR:ALCON MANUFACTURING, LTD.;REEL/FRAME:021266/0729
Effective date: 20080101
Owner name: ALCON RESEARCH, LTD.,TEXAS
Free format text: MERGER;ASSIGNOR:ALCON MANUFACTURING, LTD.;REEL/FRAME:021266/0729
Effective date: 20080101
Jul 18, 2011FPAYFee payment
Year of fee payment: 12